ORIGINAL ARTICLE Prevalence of Treatment, Risk Factors, and Management of Atrial Septal Defects in a Pediatric Medicaid Cohort C. Osborne Shuler • Avnish Tripathi • George B. Black • Yong-Moon Mark Park • Jeanette M. Jerrell Received: 26 February 2013 / Accepted: 4 April 2013 / Published online: 26 April 2013 Ó Springer Science+Business Media New York 2013 Abstract Atrial septal defects (ASDs) vary greatly depending on their size, age at closure, and clinical man- agement. This report characterizes the prevalence, com- plexity, and clinical management of these lesions in a statewide pediatric cohort and examines predictors for receiving closures. A 15-year Medicaid data set (1996–2010) from one state was analyzed. The selection criteria specified patients 17 years of age or younger with a diagnosis of ASD primum, secundum, or sinus venosus on one or more service visits to a pediatrician or pediatric cardiologist. During the 15-year period, ASDs represented a prevalence rate for treatment of 0.47/1000 CHDs iden- tified, with 61 % presenting as complex lesions. Concom- itant cardiac anomalies that might have a negative impact on prognosis were present including patent ductus arteri- osus (26.1 %), pulmonary hypertension (3.8 %), and supraventricular tachycardia (2.4 %). Pharmacologic treatments, predominantly diuretics, were prescribed for 21 % of the cohort. Both surgical closures (6.3 %) and transcatheter closures (1.4 %) were used for ASD secun- dum cases, whereas surgical closures predominated for ASD primum (25.6 %) and sinus venosus (13.5 %) lesions. The postoperative follow-up period was two to three times longer for children with ASD primum or sinus venosus than for those with ASD secundum (average, *1 year). Factors predicting the likelihood of having ASD closure were older age, having a concomitant patent ductus arte- riosus (PDA) repair, treatment with ibuprofen, having two or more concomitant CHDs, and receiving diuretics or preload/afterload-reducing agents. Care of ASDs in routine practice settings involves more complications and appears to be more conservative than portrayed in previous inves- tigations of isolated ASDs. Keywords Atrial septal defects Á Complications Á Medical intervention Á Pharmacologic intervention Á Prevalence Introduction Atrial septal defects (ASDs) are the second most common (0.07–0.2 %) congenital heart disease (CHD) in children [1]. Isolated atrial defects (excluding patent foramen ovale [PFO]) accounted for 3 % of pediatric patients with heart disease in one hospital [10], and have a female-to-male ratio of about 2:1 [1]. Approximately 15 % of ASDs close spontaneously by the age of 4 years, whereas others may decrease in size so as not to be clinically significant [1]. However, about 1 % of infants with moderate to large isolated ASDs experience symptoms (e.g., tachypnea and failure to thrive), which usually do not occur until late childhood or older. These C. O. Shuler Á G. B. Black Department of Pediatrics, University of South Carolina School of Medicine, 9 Medical Park, Suite 110, Columbia, SC 29203, USA A. Tripathi Department Medicine, University of Mississippi School of Medicine, 2500N State Street, Jackson, MS 39216, USA Y.-M. M. Park Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29203, USA J. M. Jerrell (&) Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 15 Medical Park, Suite 301, Columbia, SC 29203, USA e-mail: jeanette.jerrell@uscmed.sc.edu 123 Pediatr Cardiol (2013) 34:1723–1728 DOI 10.1007/s00246-013-0705-5